“All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.”

Universal Declaration of Human Rights

Article 1

Visitors

1041183

Health Care Fraud

Fraud under the False Claims Act
means that a contractor has knowingly presented a false claim for payment to
the United States. The fraud can occur wherever federal or state monies are
directly or indirectly used to purchase services or goods.

Medical Whistleblowers are typically
healthcare professionals who are aware of hospitals, clinics, pharmacies,
Nursing Homes, Hospices, long term care and other health care facilities that
routinely overcharge or seek reimbursement from government programs for medical
services not rendered, drugs not used, beds not slept in and ambulance rides
not taken.

Since the 1990’s more fraud cases
have been filed against against government medical health insurance programs –
Medicare, Medicaid and Tri-Care (Military—formerly CHAMPUS) than against the
defense industry.

Governmental Corruption - Transparency International

Types of Medical Fraud

Hospice care centers overbilling for patients stays
and care.

Rehabilitation centers systematically inflating
rehab bills.

Durable medical equipment fraud: kickbacks schemes
in medical sales of items such as bedding and wheelchairs.

Nursing home overbilling of staff time and patient
care.

Assisted living center fraud.

Medical coding: alteration of medical codes for
different procedures and diagnosis.

Ambulance service fraud: billing for rides not
authorized by Medicare.

"Phantom Billing" -
Billing for tests not performed.

Performing inappropriate or
unnecessary procedures.

Charging for equipment/supplies
never ordered.

Billing Medicare/Medicaid for new
equipment but providing the patient used equipment.

Offering free services or supplies
in exchange for your Medicare or Medicaid number.

"Unbundling" - Using two
or more Current Procedural Terminology ("CPT") billing codes instead
of one inclusive code for a defined panel where rules and regulations require
"bundling" of such claims. Submitting multiple bills, in order to
obtain a higher reimbursement for tests and services that were performed within
a specified time period and which should have been submitted as a single bill.

"Double Billing" —
charging more than once for the same service, for example by billing using an
individual code and again as part of an automated or bundled set of tests.

"Up Coding" - Inflating
bills by using diagnosis billing codes that indicate the patient experienced
medical complications and/or needed more expensive treatments. (eg., billing
for complex services when only simple services were performed, billing for
brand-named drugs when generic drugs were provided, listing treatment as having
been for a more complicated diagnosis than was actually the case.)

"Phantom Employees" -
Expensing employees or hours worked that do not exist.

Office of Inspector General - False and Fraudulent Claims

2011

11-17-2011

After it self-disclosed conduct to the OIG, Pitt County Memorial
Hospital (PCMH), North Carolina, agreed to pay $68,479.04 for allegedly
violating the Civil Monetary Penalties Law. The OIG alleged that PCMH
employed an individual that it knew or should have known was excluded
from participation in Federal health care programs.

11-14-2011

After it self-disclosed conduct to the OIG, Providence Hospital,
Alabama, agreed to pay $5,938.54 for allegedly violating the Civil
Monetary Penalties Law. The OIG alleged that Providence Hospital
employed an individual that it knew or should have known was excluded
from participation in Federal health care programs.

11-02-2011

After it self-disclosed conduct to the OIG, Sonoma Healthcare Center
(SHC), California, agreed to pay $106,650.11 for allegedly violating
the Civil Monetary Penalties Law. The OIG alleged that SHC employed an
individual that it knew or should have known was excluded from
participation in Federal health care programs.

10-26-2011

After it self-disclosed conduct to the OIG, New York City Health and
Hospital Corporation (HHC), New York, agreed to pay $442,909.35 for
allegedly violating the Civil Monetary Penalties Law. The OIG alleged
that HHC employed eight individuals that it knew or should have known
were excluded from participation in Federal health care programs.

10-26-2011

After it self-disclosed conduct to the OIG, Conestoga View Nursing,
L.P. d/b/a Conestoga View, Pennsylvania, agreed to pay $264,879.84 for
allegedly violating the Civil Monetary Penalties Law. The OIG alleged
that Conestoga View employed an individual that it knew or should have
known was excluded from participation in Federal health care programs.

10-06-2011

After it self-disclosed conduct to the OIG, Blue Hill Memorial
Hospital (BHMH), Maine, agreed to pay $40,000 for allegedly violating
the Civil Monetary Penalties Law. The OIG alleged that BHMH employed an
individual that it knew or should have known was excluded from
participation in Federal health care programs.

09-20-2011

After it self-disclosed conduct to the OIG, Maine Coast Memorial
Hospital (MCMH), Maine, agreed to pay $186,398.71 for allegedly
violating the Civil Monetary Penalties Law. The OIG alleged that MCMH
employed an individual that it knew or should have known was excluded
from participation in Federal health care programs.

After it self-disclosed conduct to the OIG, Cape Cod Hospital (CCH) a
subsidiary of Cape Cod Healthcare, Inc., Massachusetts, agreed to pay
$115,605.36 for allegedly violating the Civil Monetary Penalties Law.
The OIG alleged that CCH employed an individual that it knew or should
have known was excluded from participation in Federal health care
programs.

09-06-2011

After it self-disclosed conduct to the OIG, Visiting Nurse
Association of Cape Cod (VNA) a subsidiary of Cape Cod Healthcare, Inc.,
Massachusetts, agreed to pay $278,169.84 for allegedly violating the
Civil Monetary Penalties Law. The OIG alleged that VNA employed an
individual that it knew or should have known was excluded from
participation in Federal health care programs.

08-30-2011

After it self-disclosed conduct to the OIG, St. Joseph Health
Services of Rhode Island (St. Joseph), Rhode Island, agreed to pay
$123,032 for allegedly violating the Civil Monetary Penalties Law. The
OIG alleged that St. Joseph employed an individual that it knew or
should have known was excluded from participation in Federal health care
programs.

08-23-2011

Savient Pharmaceuticals, Inc. (Savient), New Jersey, agreed to pay
$100,000 to resolve Civil Monetary Penalties liability under the
Medicaid Drug Rebate Program. Savient failed to submit pricing
information and to pay a rebate to state Medicaid programs for covered
drugs that the state Medicaid programs reimburse.

08-19-2011

After it self-disclosed conduct to the OIG, Hospice of the Finger
Lakes (HFL), New York, agreed to pay $35,831.70 for allegedly violating
the Civil Monetary Penalties Law. The OIG alleged that HFL employed an
individual that it knew or should have known was excluded from
participation in Federal health care programs.

08-09-2011

After it self-disclosed conduct to the OIG, Kmart Corporation
(Kmart), Indiana, agreed to pay $945,021.19 for allegedly violating the
Civil Monetary Penalties Law. The OIG alleged that Kmart employed four
individuals that it knew or should have known were excluded from
participation in Federal health care programs.

08-09-2011

After it self-disclosed conduct to the OIG, North American Partners
in Anesthesia (NAPA), New York, agreed to pay $506,231 for allegedly
violating the Civil Monetary Penalties Law. The OIG alleged that five
physicians formerly associated with NAPA had furnished services at a
gastroenterologist's office that inaccurately reflected procedures as
having been done on two separate days when they were actually done on a
single day. The false statements resulted in higher charges and caused
NAPA to submit false claims in connection with those services.

07-25-2011

After it self-disclosed conduct to the OIG, Trustees of Indiana
University (IU), Indiana, agreed to pay $603,522 for allegedly violating
the Civil Monetary Penalties Law. The OIG alleged that IU improperly
claimed services provided by third and fourth year students in its
professional optometry degree program under the physician fee schedule.
The services could not be properly claimed under the physician fee
schedule because the students were not in a graduate medical education
program and the services were not provided in a teaching hospital or
teaching setting.

Office of Inspector General - Kickback & Self Referral Fraud Cases

In each CMP case resolved through a settlement agreement, the settling party has contested the OIG's allegations and denied any liability. No CMP judgment or finding of liability has been made against the settling party.

2011

11-29-2011

After it self-disclosed conduct to the OIG, City Hospital, Inc., The
Charles Town General Hospital d/b/a Jefferson Memorial Hospital, and
West Virginia University Hospitals-East, Inc. (collectively
respondents), West Virginia, agreed to pay $949,595 for allegedly
violating the Civil Monetary Penalties Law provisions applicable to
physician self-referrals and kickbacks. The OIG alleged that the
respondents entered into several arrangements with physicians or
physician groups for which the hospitals failed to collect office rental
payments. The conduct included: (1) payments of costs and expenses
pursuant to recruitment agreements in excess of the actual additional
incremental costs; (2) payment of student loans without a written
recruitment agreement; and (3) payment of costs and expenses pursuant to
unwritten extensions of recruitment agreements.

10-04-2011

After it self-disclosed conduct to the OIG, County of Monterey d/b/a
Natividad Medical Center (NMC), California, agreed to pay $174,508.46
for allegedly violating the Civil Monetary Penalties Law provisions
applicable to physician self-referrals and kickbacks. The OIG alleged
that NMC entered into a professional medical services agreement with a
physician group for certain call coverage and clinic services. The
compensation terms of the agreement offered incentives for the physician
group to refer their private practice and medically indigent adult
patients to NMC.

10-03-2011

After it self-disclosed conduct to the OIG, Westfields Hospital,
Wisconsin, agreed to pay $204,150 for allegedly violating the Civil
Monetary Penalties Law provisions applicable to physician self-referrals
and kickbacks. The OIG alleged that Westfields Hospital provided space,
services, and supplies to certain physician group practices without
entering into a formal written contract and without collecting payment.

9-08-2011

After it self-disclosed conduct to the OIG, Whidbey Island Hospital
District (WIHD), Washington, agreed to pay $858,571 for allegedly
violating the Civil Monetary Penalties Law provisions applicable to
physician self-referrals and kickbacks. The OIG alleged that WIHD had
over 100 violations surrounding various physician contracts and
arrangements. Some of the violations included: (1) a number of
hospitalist contracts had expired and new contracts had not been signed;
(2) there were no written agreements in place for a number of medical
staff leadership and call coverage arrangements; and (3) a variety of
improper lease arrangements, personal service arrangements, malpractice
subsidies, and a housing allowance and an equipment loan with one
physician.

07-13-2011

After it self-disclosed conduct to the OIG, Good Samaritan Hospital
Medical Center (GSHMC), New York, agreed to pay $55,018.50 for allegedly
violating the Civil Monetary Penalties Law provisions applicable to
physician self-referrals and kickbacks. The OIG alleged that GSHMC
entered into an improper financial relationship with a physician
professional corporation. The contract did not specify the terms of the
intended agreement and the physician profession corporation received
accelerated payments from GSHMC that did not comply with contractually
agreed to payments. The payments were not consistent with fair market
value.

07-13-2011

After it self-disclosed conduct to the OIG, St. Catherine of Siena
Medical Center (St. Catherine), New York, agreed to pay $2,596,014 for
allegedly violating the Civil Monetary Penalties Law provisions
applicable to physician self-referrals and kickbacks. The OIG alleged
that St. Catherine contracted with a physician owned professional
services company. The company received remuneration that was not
consistent with fair market value and received payments for services
that were not performed under the contract.

05-11-2011

After it self-disclosed conduct to the OIG, Pacifica Hospital of the
Valley (Pacifica), California, agreed to pay $764,250 for allegedly
violating the Civil Monetary Penalties Law provisions applicable to
physician self-referrals and kickbacks. The OIG alleged that Pacifica
paid indirect improper remuneration to a physician in the form of
payments to a marketing firm for marketing services that were never
rendered under joint marketing agreements. The remuneration created a
financial relationship between Pacifica and the physician that caused
Pacifica to present claims for health services that resulted from
prohibited referrals in violation of the Stark law.

03-24-2011

After it self-disclosed conduct to the OIG, Fairview Northland
Regional Health Care (FNRHC), Minnesota, agreed to pay $50,000 for
allegedly violating the Civil Monetary Penalties Law provisions
applicable to physician self-referrals and kickbacks. The OIG alleged
that FNRHC entered into an unwritten lease agreement with a physician
practice.

2010

12-03-2010

After it self-disclosed conduct to the OIG, Wayne County Hospital
(WCH), Kentucky, agreed to pay $110,000 for allegedly violating the
Civil Monetary Penalties Law provisions applicable to physician
self-referrals and kickbacks. The OIG alleged that WCH: 1) paid
remuneration to a physician by failing to charge processing fees for
payroll services rendered to his practice; 2) paid remuneration to a
physician and failed to demand or collect payroll processing fees and
payments due for personnel and practice management support services
rendered to her practice; and 3) paid remuneration to two physicians by
failing to demand repayment of wages and benefits paid to the physicians
and their staff and failed to charge processing fees for payroll
services rendered to the practice.

11-09-2010

After it self-disclosed conduct to the OIG that it discovered had
occurred at another hospital with which it had merged, St. Elizabeth
Medical Center, Kentucky, agreed to pay $1,216,511 for allegedly
violating the Civil Monetary Penalties Law provisions applicable to
physician self-referrals and kickbacks. The OIG alleged that St.
Elizabeth entered into an improper billing arrangement for
"provider-based services" involving a rural outreach program that had
occurred at another hospital prior to its acquisition by St. Elizabeth.
In addition, the OIG alleged that the acquired hospital entered into
several improper financial relationships with a referring physician that
violated the Stark Law and the Anti-Kickback Statute.

10-21-2010

Steven J. Lancaster, M.D., Florida, agreed to pay $101,000 for
allegedly violating the Civil Monetary Penalties Law provisions
applicable to kickbacks. The OIG alleged that Dr. Lancaster solicited
kickbacks from a medical device manufacture. Dr. Lancaster sought to
leverage his product usage and ability to influence purchasing decisions
in exchange for a consulting agreement with a guaranteed payment. In
addition, he sought to obtain a personal service agreement.

09-03-2010

After it self-disclosed conduct to the OIG, South Coast Medical
Center (SCMC), California, agreed to pay $72,637.77 for allegedly
violating the Civil Monetary Penalties Law provisions applicable to
physician self-referrals and kickbacks. The OIG alleged that SCMC
entered into multiple lease and personal services arrangements with
doctors that raised compliance issues under the Stark Law and
Anti-Kickback Statute.

07-21-2010

After it self-disclosed conduct to the OIG, Mercy Medical Center,
Inc. (MMC), Maryland, agreed to pay $195,013.50 for allegedly violating
the Civil Monetary Penalties Law provisions applicable to physician
self-referrals and kickbacks. The OIG alleged that MMC entered into
physician service arrangements, lease arrangements, physician on-call
arrangements and billing and collection agreements that raised potential
issues under the Stark Law and the Anti-Kickback Statute.

07-08-2010

United Shockwave Services, United Urology Centers, and United
Prostate Centers (collectively, United), Illinois, agreed to pay
$7,359,500 and entered into a five year CIA for allegedly violating the
Civil Monetary Penalties Law provisions applicable to physician
self-referrals and kickbacks. The OIG alleged that United and certain
physician-investors used their ability to control patient referrals to
obtain contract business from various hospitals. Specifically, United
threatened hospitals that it would refer patients to competing hospitals
if the respective hospital did not agree to a contract with United, or
promised hospitals that did contract with United additional referrals.
The relationships between United's physician-investors and the hospitals
raised Stark concerns regarding the financial relationships between
United's physician-investors and the hospitals to which they made
referrals. Also, United sold more shares to physicians who produced
more referrals or other business for the company. United had processes
for having physicians divest if they did not use United's services
sufficiently and offered huge returns on investment with virtually no
business risk.

06-17-2010

After it self-disclosed conduct to the OIG, St. John's Regional
Medical Center (SJRMC), Missouri, agreed to pay $274,815 for allegedly
violating the Civil Monetary Penalties Law provisions applicable to
physician self-referrals and kickbacks. The OIG alleged that SJRMC
entered into an improper financial relationship with a physician. SJRMC
allowed the physician to be regularly delinquent in rent under a
written lease agreement and paid the physician for services without a
written contract in place.

06-07-2010

After it self-disclosed conduct to the OIG, Christus Spohn Hospital
Corpus Christi- Memorial (Memorial), Texas, agreed to pay $4,130,536 for
allegedly violating the Civil Monetary Penalties Law provisions
applicable to physician self-referrals and kickbacks. The OIG alleged
that: (1) Memorial paid indirect remuneration to family medicine and
emergency medicine faculty physicians in the form of (a) salary and
benefit reimbursements to the faculty physicians' employer that were
more than fair market value for the time the physicians spent fulfilling
their contractual duties to Memorial and (b) billing and collections
services associated with the faculty physicians' practices to an
educational foundation and successor entity; (2) Memorial paid
remuneration to certain family medicine faculty physicians in the form
of charging rent below fair market value for office space on the fifth
and sixth floors of Memorial's hospital; and (3) Memorial paid
remuneration to two entities providing services proscribed by the
Ethical and Religious Directives for Catholic Health Care Services in
the form of the entities' staffing, equipment, and billing for the
facility fees associated with the proscribed services and paying those
fees to the involved entities.

06-03-2010

Cochlear Americas, Colorado, agreed to pay $880,000 for allegedly
violating the Civil Monetary Penalties Law provisions applicable to
kickbacks. The OIG alleged that Cochlear Americas paid various forms of
illegal remuneration to physicians who prescribed the use of their
manufactured implant system for Medicare and Medicaid patients.

05-11-2010

After it self-disclosed conduct to the OIG, Surgical Specialty
Center of Baton Rouge, LLC (provider), Louisiana, agreed to pay $51,300
for allegedly violating the Civil Monetary Penalties Law provisions
applicable to the Stark Law. The OIG alleged that the provider entered
into several types of financial arrangements with referring physicians
without the requisite written agreements in place as required by the
Stark Law.

05-03-2010

After it self-disclosed conduct to the OIG, Colorado West HealthCare
System d/b/a Community Hospital and its subsidiary, Doctor's Clinic
Building, Inc. (Colorado West), Colorado, agreed to pay $420,175 for
allegedly violating the Civil Monetary Penalties Law provisions
applicable to kickbacks and physician self-referrals. The OIG alleged
that Colorado West entered into six categories of contractual
arrangements (i.e., medical director arrangements, emergency room
services, office leases, on-call physician arrangements, continuing
medical education services, and diagnostic test interpretations) that
violated the Stark Law and, in some instances, implicated the
Anti-Kickback Statute in connection with physicians' referrals of
Medicare beneficiaries to Colorado West.

04-20-2010

After it self-disclosed conduct to the OIG, St. Elizabeth Hospital
and Mercy Medical Center of Oshkosh, Inc. (hospitals), Wisconsin, both
part of the Affinity Health System, agreed to pay $54,124 for allegedly
violating the Civil Monetary Penalties Law provisions applicable to the
Stark Law. The OIG alleged that the hospitals disclosed payments to
three independent psychiatrists who provided behavioral health services
at the hospitals' emergency rooms. Specifically, the on-call coverage
arrangements between the psychiatrists and hospitals failed to comply
with Stark Law requirements.

03-31-2010

After it self-disclosed conduct to the OIG, St. James Healthcare
(SJH), Montana, agreed to pay $275,000 for allegedly violating the Civil
Monetary Penalties Law provisions applicable to the Stark Law. The OIG
alleged that SJH entered into a space lease, an employee lease, and a
medical services arrangement with an entity partly owned by SJH that
failed to meet Stark Law requirements because they were not set forth in
writing and signed.

03-01-2010

After it self-disclosed conduct to the OIG, Liberty HealthCare
Systems, Inc. (Liberty), New Jersey, agreed to pay $225,000 to resolve
its liability for allegedly violating the Civil Monetary Penalties Law
provisions applicable to the Stark Law. The OIG alleged that Liberty
made an improper bonus payment to an employee physician based, in part,
on the volume and value of referrals made by the physician.

02-16-2010

Harvey Montijo, M.D., Florida, agreed to pay $650,000 for allegedly
violating the Civil Monetary Penalties Law provisions applicable to
kickbacks. The OIG alleged that Dr. Montijo solicited and received
remuneration in the form of consulting payments from two medical device
manufactures in exchange for using their orthopedic hip and knee
products.

02-08-2010

Garden State Imaging (GSI), New Jersey, agreed to pay $83,000 for
allegedly violating the Civil Monetary Penalties Law provisions
applicable to kickbacks. The OIG alleged that GSI entered into a verbal
agreement with two owners of a medical center. Under the terms of the
verbal agreement, GSI agreed to provide mobile diagnostic imaging and
related services to the medical center's patients and to split with the
medical center 50% of the net proceeds that were generated.

01-22-2010

After it self-disclosed conduct to the OIG, St. Mary Medical Center -
Long Beach (St. Mary), California, agreed to pay $494,374 for allegedly
violating the Civil Monetary Penalties Law provisions applicable to
kickbacks. The OIG alleged that St. Mary paid remuneration to a medical
group and its owner in the form of administrative services from a St.
Mary's employee and paid remuneration through leased space and a medical
director agreement.

01-06-2010

After it self-disclosed conduct to the OIG, Inland Imaging, LLC
(Inland), Washington, agreed to pay $155,000 for allegedly violating the
Civil Monetary Penalties Law provisions applicable to the Stark Law.
The OIG alleged that Inland provided certain outpatient radiology
services to Medicare beneficiaries based on orders written by physicians
who were immediate family members of three individuals who held
indirect ownership interests in Inland.

2009

12-10-2009

After it self-disclosed conduct to the OIG, Piedmont Hospital, Inc.,
Georgia, agreed to pay $126,322 for allegedly violating the Civil
Monetary Penalties Law provisions applicable to kickbacks and physician
self-referrals. The OIG alleged that Piedmont's financial relationships
with 22 physicians failed to meet Stark law and Anti-Kickback statute
requirements. The majority of the arrangements involved payment for
services performed without a fully-executed written contract, one
arrangement involved a physician who was paid at rates differing from
the contract rate, and other arrangements involved payment for services
that were not set forth in a contract.

12-02-2009

After it self-disclosed conduct to the OIG, Oswego Hospital, New
York, agreed to pay $2,134,037 for allegedly violating the Civil
Monetary Penalties Law provisions applicable to kickbacks and physician
self-referrals. The OIG alleged that Oswego's financial relationships
with more than 20 physicians failed to meet Stark law requirements.
Most of the violations involved the hospital's failure to comply with
Stark law requirements for recruitment arrangements, office leases,
professional service arrangements, and the provision of discounted
employee benefit plan premiums to non-employed physicians.

11-04-2009

After it self-disclosed conduct to the OIG, Allied Health Care
Corporation (Allied), Florida, agreed to pay $132,500 for allegedly
violating the Civil Monetary Penalties Law provisions applicable to
kickbacks and physician self-referrals. The OIG alleged that two
physicians that were shareholders in Allied made referrals to two home
health agencies which were wholly owned subsidiaries of Allied.

10-20-2009

Robert Diaz, M.D. (Diaz), Florida, agreed to pay $65,000 and to be
excluded from participating in Federal health care programs for three
years for allegedly violating the Civil Monetary Penalties Law
provisions applicable to kickbacks. The OIG alleged that Diaz solicited
and received remuneration in the form of consulting payments from a
medical device manufacturer in exchange for using their orthopedic hip
and knee products.

10-16-2009

After it self-disclosed conduct to the OIG, Medina General Hospital
(MGH), Ohio, agreed to pay $240,298 for allegedly violating the Civil
Monetary Penalties Law provisions applicable to kickbacks and physician
self-referrals. The OIG alleged that MGH's financial relationships with
a family practice physician, occupational health services physicians,
and a cardiologist failed to meet Stark Law requirements. Specifically,
the financial relationships were during periods when there were no
written service agreements or payments were not made consistent with the
contracts.

After it self-disclosed conduct to the OIG, Vascular Specialty
Services, Inc. (VSSI), Maryland, agreed to pay $34,182 for allegedly
violating the Civil Monetary Penalties Law provisions applicable to
kickbacks and physician self-referrals. The OIG alleged that VSSI's
financial relationship with four vascular surgeons failed to meet Stark
law requirements. Specifically, VSSI added lab referral revenues into a
bonus pool that was paid to the vascular surgeons.

09-25-2009

Michael Bakst, the former Executive Director of Community Memorial
Hospital (CMH) of Ventura, California, agreed to pay $64,000 for
allegedly violating the Civil Monetary Penalties Law provisions
applicable to kickbacks. The OIG alleged that Bakst caused the
submission of claims to Medicare in violation of the physician
self-referral (Stark) law. During the relevant time period Bakst was
also identified as CMH's Compliance Officer.

09-17-2009

After it self-disclosed conduct to the OIG, Liberty HealthCare
System, Inc. (Liberty), New Jersey, agreed to pay $417,675 for allegedly
violating the Civil Monetary Penalties Law provisions applicable to
kickbacks. The OIG alleged that one of Liberty's hospitals failed to
reflect an increase in compensation and hours of service in a written
pediatric coverage agreement with a physician practice that provided
pediatric coverage services to MHMC.

08-11-2009

After it self-disclosed conduct to the OIG, Cushing Memorial
Hospital (CMH), Kansas, agreed to pay $50,000 for allegedly violating
the Civil Monetary Penalties Law provisions applicable to kickbacks and
physician self-referrals. The OIG alleged that CMH's financial
relationship with a cardiologist failed to meet Stark Law requirements.
Specifically, the cardiologist was engaged to provide medical director
services to CMH's cardiac rehabilitation unit. However, the written
agreement was not signed. In addition, CMH's office space lease with
the cardiologist did not meet the applicable lease exception.

08-03-2009

After it self-disclosed conduct to the OIG, Central Kansas Medical
Center (CKMC), Kansas, agreed to pay $50,000 for allegedly violating the
Civil Monetary Penalties Law provisions applicable to kickbacks and
physician self-referrals. The OIG alleged that CKMC entered into two
lease arrangements, with a referring-physician-owned partnership, that
failed to comply fully with the Stark law's requirements for such
financial arrangements.

07-31-2009

After self-disclosing to the OIG, Kahuku Hospital, Hawaii, agreed to
pay $75,000 for allegedly violating the Civil Monetary Penalties Law
provisions applicable to kickbacks and physician self-referrals. The OIG
alleged that Kahuku Hospital entered into services agreements with
emergency room physicians where payments were made in excess of the
amount provided for in the agreement and entered into other arrangements
with emergency room physicians that were not in writing.

07-10-2009

After it self-disclosed conduct to the OIG, Inova Health Care
Services d/b/a Inova Fairfax Hospital (Inova), Virginia, agreed to pay
$528,158 for allegedly violating the Civil Monetary Penalties Law
provisions applicable to kickbacks and physician self-referrals. The OIG
alleged that Inova paid remuneration to Arrhythmia Associates (AA) in
the form of services provided by certain physician assistants (PA)
within the office of AA. Specifically, Inova provided PA services to AA
without written contracts in place and failed to bill and collect for
those PA services.

06-26-2009

After it self-disclosed conduct to the OIG, Memorial Hospital of
Union County (MHUC), Ohio, agreed to pay $31,202 for allegedly violating
the Civil Monetary Penalties Law provisions applicable to kickbacks and
physician self-referrals. The OIG alleged that MHUC provided excess
non-monetary compensation to physicians and the immediate family member
of a physician who referred patients to MHUC.

02-09-2009

After it self-disclosed conduct to the OIG, Jewish Hospital and St.
Mary's Healthcare (JHSMH), Kentucky, agreed to pay $130,000 for
allegedly violating the Civil Monetary Penalties Law provisions
applicable to kickbacks and physician self-referrals. The OIG alleged
that JHSMH entered into an arrangement with a physician for a Medical
Director position that included the physician being paid compensation in
excess of his Medical Director agreement and receiving free nurse
services for his private practice without any contractual entitlement to
such services.

01-27-2009

After it self-disclosed conduct to the OIG, San Jacinto Methodist
Hospital (SJMH), Texas, agreed to pay $21,025.62 for allegedly violating
the Civil Monetary Penalties Law provisions applicable to kickbacks and
physician self-referrals. The OIG alleged that SJMH entered into an
arrangement with a physician for a Medical Director position that
included the physician occupying hospital space for private use and
utilizing hospital personnel for clerical assistance related to the
physician's private practice patient visits without any contractual
entitlement to do so.

2008

12-03-2008

After it self-disclosed conduct to the OIG, The King's Daughters'
Hospital and Health Services (Hospital), Indiana, agreed to pay $391,500
for allegedly violating the Civil Monetary Penalties Law provisions
applicable to kickbacks. The OIG alleged that the Hospital had
compensation arrangements with employed physicians that failed to comply
fully with the Stark Law's restrictions on productivity bonuses.
Specifically the physicians were compensated for services that were not
personally performed by them.

11-26-2008

After self-disclosing conduct to the OIG, Bioscrip, Inc. and
Bioscrip Pharmacy, Inc. (Bioscrip), agreed to pay $795,000 for allegedly
violating the Civil Monetary Penalties Law provisions applicable to
kickbacks and prohibited physician self-referrals. The OIG alleged that
Bioscrip stationed a pharmacist, from its West Hollywood, California
pharmacy, at two physician practices and that, while on-site at the
physician practices, the pharmacist provided services for the pharmacy
with the practices as well as services that benefitted the physician
practices (without a lease), including services that otherwise would
have been provided to patients by the physician practices. Patients of
the physician practices, including those counseled by the on-site
Bioscrip pharmacist, were referred to and filled prescriptions paid for
by the Medicare Part D program at a Bioscrip pharmacy.

11-04-2008

Abbott Northwestern Hospital, Minnesota, agreed to pay $350,000 for
allegedly violating the Civil Monetary Penalties Law provisions
applicable to physician self-referrals. The OIG alleged that Abbott made
physician salary guarantee payments to three Sports and Orthopedic
Specialists without entering into written physician recruitment
agreements with the recruited physicians.

10-01-2008

Valerie Tolley d/b/a Health Care Medical (HCM), Mississippi, agreed
to pay $100,000 for allegedly violating the Civil Monetary Penalties Law
provisions applicable to kickbacks. The OIG alleged that HCM made
payments and attempted to make payments of kickbacks in exchange for
direct and indirect patient referrals.

08-11-2008

After it self-disclosed conduct to the OIG, Ivinson Hospital,
Wyoming, agreed to pay $635,000 for allegedly violating the Civil
Monetary Penalties Law provisions applicable to kickbacks. The OIG
alleged that Ivinson paid prohibited remuneration to physicians in the
form of free rent, equipment and furnishings, leases at
less-than-fair-market value, reimbursement for medical-director services
in excess of fair-market value, and reimbursement in excess of the
requirements of an income-guarantee agreement.

Office of Inspector General - Medical Fraud

08-23-2011

Savient Pharmaceuticals, Inc. (Savient), New Jersey, agreed to pay
$100,000 to resolve Civil Monetary Penalties liability under the
Medicaid Drug Rebate Program. Savient failed to submit pricing
information and to pay a rebate to state Medicaid programs for covered
drugs that the state Medicaid programs reimburse.

05-15-2007

Lee R. Rocamora, M.D., North Carolina, agreed to pay $106,600 to
resolve his liability for allegedly violating the Civil Monetary
Penalties Law. The OIG alleged that the practitioner requested payments
from Medicare beneficiaries in violation of his assignment agreement.
Specifically, the practitioner allegedly asked his patients to enter
into a membership agreement for his patient care program, under which
the patients paid an annual fee. In exchange for the fee, the membership
agreement specified that the practitioner would provide members with:
(1) an annual comprehensive physical examination; (2) same day or next
day appointments; (3) support personnel dedicated exclusively to
members; (4) 24 hours a day and 7 days a week physician availability;
(5) prescription facilitation; (6) coordination of referrals and
expedited referrals, if medically necessary; and (7) other service
amenities as determined by the practitioner.

07-28-2003

A physician from Minneapolis, Minnesota, agreed to pay $53,400 to
resolve his liability under the CMP provision applicable to violations
of a provider's assignment agreement. By accepting assignment for all
covered services, a participating provider agrees that he or she will
not collect from a Medicare beneficiary more than the applicable
deductible and coinsurance for covered services. The OIG alleged that
the physician created a program whereby the physician's patients were
asked to sign a yearly contract and pay a yearly fee for services that
the physician characterized as "not covered" by Medicare. The OIG
further alleged that because at least some of the services described in
the contract were actually covered and reimbursable by Medicare, each
contract presented to the Medicare patients constituted a request for
payment other than the coinsurance and applicable deductible for covered
services in violation of the terms of the physician's assignment
agreement. In addition to payment of the settlement amount, the
physician agreed not to request similar payments from beneficiaries in
the future.

11-07-2007

America's Health Choice, Inc. (AHC), Florida, agreed to pay $100,000
to resolve its liability under the OIG's CMP provision applicable to
any Medicare Advantage organization that misrepresents or falsifies
information to the Secretary of HHS (Secretary). The OIG alleged that
AHC submitted documents to the Secretary on at least three occasions
that misrepresented the academic credentials of an AHC employee and
submitted at least seven effectuation notices to the Center for Health
Care Dispute Resolution (CHDR) in which dates of submission had been
falsified to appear in compliance with CHDR's request for claims data.

12-31-2001

Molina Medical Centers, a California Medicaid managed care plan,
agreed to pay $600,000 to resolve its liability under the OIG's CMP
provision applicable to any Medicaid managed care organization that
misrepresents or falsifies information to an individual. The OIG alleged
that the managed care plan sent misleading letters to its Medicaid
enrollees in an effort to persuade the enrollees to continue to choose
it as their Medicaid managed care plan. The OIG alleged that the letters
appeared to be written and signed by the enrollees' primary care
physicians even though they were actually written and signed by
employees of the managed care plan.

“Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around.”

"Never impose on others what you would not choose for yourself." Confucius

"It is not the critic who counts; not the man who
points out how the strong man stumbles, or where the doer of deeds
could have done them better. The credit belongs to the man who is
actually in the arena, whose face is marred by dust and sweat and
blood; who strives valiantly; who errs, who comes short again and
again, because there is no effort without error and shortcoming; but
who does actually strive to do the deeds; who knows great enthusiasms,
the great devotions; who spends himself in a worthy cause; who at
the best knows in the end the triumph of high achievement, and who
at the worst, if he fails, at least fails while daring greatly, so
that his place shall never be with those cold and timid souls who
neither know victory nor defeat."

Theodore
Roosevelt- Excerpt from the speech "Citizenship In A Republic",
delivered at the Sorbonne, in Paris, France on 23 April, 1910

Medical Whistleblower Commitment to Non-Violence

Medical Whistleblower has a commitment to improving the protection of all civil, political, economic, social and cultural rights as defined in, among others, the following regional and international legal instruments:

• UN legal instruments pertaining to human rights, including: the Universal Declaration of Human Rights; the international covenants on civil and political rights and on economic, social and cultural rights; the conventions providing for monitoring mechanisms (torture, racial discrimination, discrimination against women, the rights of the child, rights of migrant workers and their families); and the conventions and standards of the International Labor Organization;

• Special procedures and non-treaty mechanisms of the United Nations;

• The Declaration on Human Rights Defenders;

• The UN resolution establishing the mandate of the Special Representative of the Secretary General on human rights defenders;

• The United Nations guidelines on human rights defenders;

In addition, Medical Whistleblower upholds the principle of a code of ethical and moral conduct that all means used by Medical Whistleblower will not include violence - We exclude the use of violence to advance political aims. We work with and in collaboration with existing governmental structures and systems but put pressure on governments in a non-violent manner to achieve human rights protections and goals.

"The human voice can never reach the distance that is covered by the still small voice of conscience."

“When we call anything a person’s right, we mean that he has a
valid claim on society to protect him in the possession of it, either by the
force of law, or by that of education and opinion”

John Stuart Mill

"The adversarial system of justice is by nature unfair and unjust. It favours the strongover the weak. It accentuates social and cultural differences, favouring the rich whoare able to engage and pay for the services of one or more layers."

Justice MinisterMadame Guigou, 1999

“Everything that is done in this world is done by hope.”
―Martin Luther

Protect Medical Whistleblowers

“The most powerful individual in the state will be cautious of committing any flagrant invasion of another’s right, when he knows that the fact of his oppression must be examined and decided by twelve indifferent men.”

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“I am only one,
But still I am one.
I cannot do everything,
But still I can do something;
And because I cannot do everything,
I will not refuse to do the something
that I can do.”
― Edward Everett Hale

Film on Residential Child Abuse

Over the GW - Available on DVD

Make Torture of US Citizens on US Soil illegal

IF YOU NEED HELP

Vietnam
Veterans of America, Crisis Phone Number. Special
Notice: If you are a veteran in emotional crisis and need help RIGHT NOW, call
this toll-free number 1-800-273-8255 available 24/7, and tell them you are a
veteran. All calls are confidential. http://www.vva.org/.

Veterans’
Crisis Intervention Hotline: 1-888-899-9377.
A Crisis Intervention Hotline has been established by the VA Heartland Network
to assist veterans who may be dealing with a mental health crisis or difficult
issue in their lives. The hotline will also aid family members or friends of
veterans who need help in assisting a veteran in crisis.

Safe Harborincludes links to find medical doctors (by zip code) who can assist with helping people safely get off of psychiatric drugs and medical personnel who will treat people without the use of psychiatric drugs.